HomeMy WebLinkAboutMiscellaneous - 570 PLEASANT STREET 4/30/2018 .rte �/P��c:7��S'T
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Commonwealth of Massachusetts.
100063998
Asbestos Notification Form ANF-001 Decal Number
RECEIVED
NOV 13 2007
lmportant: A. Asbestos Abatement Description tion TOM OF NORTH ANDOVER
When filling out HEALTH DEPARTMENT
forms on the
computer,use 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied
only the tab key residence of four units or less?y❑Yes ✓❑No
to move your
cursor-do not b. Provide blanket decal number if applicable: Blanket Decal Number
use the return
key. 2. Facility Location:
NATIONAL GRID NORTH ANDOVER#7 570 PLEASANT STRE
a.Name of Facility b.Street Address
EatNORTH ANDOVER MA 0c.City/Town d.State . ' ode f.Telephone Number
INSTRUCTIONS 3. Worksite Location:
1.All sections of this 1ST FLOOR BATTERY CABIJ INET D D D
form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room
completed in order
to comply with 4. Is the facility occupied? ✓❑Yes ❑ No
DEP notification
requirements of 310
CMR 7.15 5. Asbestos Contractor:
and the Division
of Occupational LVI ENVIRONMENTAL SERVICES INC 401-S SECOND STREET
Safety(DOS) a.Name b.Address
notification EVERETT 02149 6173898880
requirements of 453
CMR 6.12 C.Cit /Town d.Zip Code e.Telephone Number
FA C000097
f.DOS License Number g. Contract Type: ❑✓ Written ❑Verbal
BRIAN DALY NATIONAL GRID REPRESENTATIVE
h.Facility Contact Person i.Contact Person's Title
MOEUN SEM AS032904
6' a.Name of On-Site Supervisor/Foreman b.Su ervisor/Foreman DOS Certification Number
7' COVING IAA000006
a.Name of Project Monitor b.Project Monitor DOS Certification Number
YEE CONSULTING GROUP IAA000145
8' a.Name of Asbestos Analytical Lab b.Asbestos Analytical Lab DOS Certification Number
11/16/2007111/21/2007..
�0 9' a.Project Start Date mm/dd/ b.End Date(mm/dd/yyy ) _
�0 8AM-4PM I N/A
�N c.Work hours Mon-Fri. d.Work hours Sat-Sun.
=0 10. a. What type of project is this?
0 ❑ Demolition ❑✓ Renovation
— ❑ Repair ❑ Other, please specify: b.Describe
11. a. Check abatement procedures:
o ❑ Glove bag ❑ Encapsulation
—o ❑ Enclosure ❑ Disposal only
=LL ❑ Cleanup ❑✓ Other, specify: SAFE WORK PRACTICE
❑ Full containment b.Describe
—z
�Q 12. Is the job being conducted: ❑✓ Indoors? ❑Outdoors?
anf001 ap.doc• 10/02 Asbestos Notification Form•Page 1 of 3
Commonwealth of Massachusetts
100063998
i;
Decal Number
Asbestos Notification Form ANF-001
A. Asbestos Abatement Description (cont.)
13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or
encapsulated:
10
250
a.Total pipes or ducts(—finea�ft) otal other su aces square
c.Boiler,breaching,duct,tank d.Insulating cement
surface coatings Lin.ft. Sq.ft. Lin.ft. Sq.ft.r
e.Corrugated or layered paper I� f.Trowel/Sprayer coatings I
pipe insulation Lin.ft. (Sq.ft. (Lin.ft. Sq.ft.
g.Spray-on fireproofing L�___1 h.Transite board,wall board L —! 250
Lin.ft. Sq.ft. Lin.ft. Sq.
I.Cloths,woven fabrics I - - j.Other,please specify'. = F
Line g� Lin.ft. S .ft.
k.Thermal,solid core pipe
insulation Lin.ft. Sq.ft. I.Specify
14. Describe the decontamination system(s)to be used:
NIA-SAFE WORK PRACTICES WILL BE UTILIZED
15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR
6.14(2) (g):
ACM WILL BE WET(HAND TO BAG)ACM WILL BE LABELED, PACKAGED &TRANSPORTED
16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency:
N/A
a.Name of DEP Official b.Title
c.Date(mm/dd/yyyy)of Authorization d.DEP Waiver#
N/A
e.Name of DOS Official f.DOS Official Title
g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver#
N
0 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? Yes Q No
.- B. Facility Description
N NATIONAL GRID SITE
0 1. Current or prior use of facility:
�o
2. Is the facility owner-occupied residential with 4 units or less? ❑Yes ✓1 No
NATIONAL GRID 15 PELHAM AVENUE
3' a.Facility Owner Name b.Address
o
METHUEN, MA 01844 978-682-2481
o c.City/Town d.Zip Code e.Telephone hone Number area code and extension
BRAIN DALY 15 PELHAM AVENUE
LL
4' a.Name of Facility Owner's On-Site Manager b.On-Site Mana er Address
Z METHUEN, MA 01844 978-682-2481
�Q c.City/Town d.Zip Code e.Telephone Number(area code and extension)
anf001 ap.doc•10/02 Asbestos Notification Form-Page 2 of 3
d
Commonwealth of Massachusetts
100063998
Asbestos Notification Form ANF-001 Decal Number
B. Facility Description (cont.)
N/A
5' a.Name of General Contractor b.Address
c.Cit /Town d.Zip Code e.Telephone Number area code and extension
f.Contractor's Worker's Comp.Insurer ..Policy � h.Exp.Date(mm/ddiYffl�
6. What is the size of this facility? a.Square Feet bb..Number of floors
C. Asbestos Transportation and Disposal
1. Transporter of asbestos-containing material from site to temporary storage site (if necessary):
LVI ENVIRONMENTAL SERVICES INC. 401-S SECOND STREET
Note:Transfer a.Name of Transporter b.Address
Stations must IEVERETT, MA �� 02149 (617) 389-8880
comply with the c.City/Town d.Zip Code e.Telephone Number
Solid Waste
Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site:
Regulations 310
CMR 19.000 IRED TECHNOLOGIES 10 NORTHWOOD DRIVE
a.Name of Transporter b.Address
BLOOMFIELD, CT 7 06002 (860)218-2428
c.Cit /Town d.Zip Code e.Telephone Number
3. INA
a.Refuse Transfer Station and Owner b.Address
I ^�
c.Cit /Town d.Zip Code e.Telephone Number
4. ITURNKEY LANDFILL(WASTE MGT NH)
a.Final Disposal Site Location Name b.Final Dis osal Site Location Owner's Name
7 ROCHESTER NECK ROAD I IROCHESTER
c.Final Disposal Site Address d.Cit /Town
NH 7 03839
e.State_ f.Zip Code g.Telephone Number
�O
D. Certification
N�N p
The undersigned hereby states, under the ISARAH MARCONE
penalties of perjury,that he/she has read the a.Name b.Authorized Signature
o Commonwealth of Massachusetts regulations PROJECTS COORDINAT 1 111/02/2007
for the Removal,Containment or c.Position/Title d.Date(mm/dd/yyyy)
Encapsulation of Asbestos,453 CMR 6.00 and (617) 389-8880 LVI
310 CMR 7.15, and that the information
contained in this notification is true and correct e.Telephone Number f.Representing
to the best of his/her knowledge and belief. 401-S SECOND STREET
o.Address _
u_
EVERETT, MA 02149
h.City/Town i.Zip Code
z
9�Q
anf001 ap.doc•10/02 Asbestos Notification Form-Page 3 of 3
_= _ LVI Environmental Services Inc.
401-S Second Street
Everett,MA 02149
SERV�CES—� Tel: (617)389-8880
Fax: (617)389-9502
www.lviservices.com
November 2, 2007
NOTIFICATION OF ASBESTOS ABATEMENT
ATTENTION: North Andover Health Department
1600 Osgood Street
l i ^� S .l u� "4
13uirar�ng tCv—�t�rte#1
Andover,MA 01845
LVI Environmental Services Inc.will be conducting an asbestos abatement project at the
following location. Please note the site and dates listed below, with the latter being subject to
changes. Do not hesitate to contact our office for more detailed scheduling information at 617-
389-8880.
BUILDING LOCATION: National Grid Site
570 Pleasant Street
North Andover,MA 01845
START DATE: 11/16/07
END DATE: 11/21/07
Asbestos signs will be clearly posted in all areas where work is being conducted. Please take the
necessary precautions in the event you are required to enter the building during an emergency.
If you have further questions with respect to this abatement project,please do not hesitate to
contact our office at any time at(617) 389-8880. Thank you very much for your attention
regarding this matter.
Very truly yours,
LVI ENVIRONMENTAL SERVICES INC.
Sarah Marcone
Projects Coordinator
